'Asylum' nostalgia misplaced

Twenty years ago, I made a programme for RTÉ's Today Tonight on people who had died or been injured in psychiatric hospital in…

Twenty years ago, I made a programme for RTÉ's Today Tonight on people who had died or been injured in psychiatric hospital in unexplained circumstances. In all cases, the families of those patients had received no adequate explanation as to what had occurred. A number of hospitals were involved, but the worst of them was St Ita's in Portrane.

At the time, St Ita's (and indeed the other hospitals) denied us permission to film on their premises and refused to answer our questions. The message was clear: patients and their families had no rights; psychiatric hospitals and the psychiatrists who ran them were untouchable.

Interesting then in this context to watch last Monday's first instalment of The Asylum, a four-part RTÉ documentary series on St Ita's. According to its makers, they were allowed full access to the hospital, its patients and staff. There can be no doubt that this openness on the part of St Ita's is a welcome mark of progress.

There was, however, a certain softness in the documentary's approach, even at times a sense of nostalgia for the grand old days when it catered for a population of 2,200.

READ MORE

Nostalgia of this kind is wildly misplaced when it comes to looking at the role played by psychiatric hospitals during much of the 20th century in Ireland. Taking a snapshot from 1956, a time when many of those we saw on the documentary would have been committed, the figures reveal a startling picture of how psychiatric institutions were used as a naked means of societal control .

A recent book, Crime, Punishment and the Search for Order in Ireland, published by the Institute of Public Administration, provides figures for the 1950s contrasting the prison population to that in psychiatric hospitals.

During 1956, there were 373 people in prison at any one time. However, there were a staggering 19,000 locked in psychiatric institutions against their will, of whom 9,850 were male and 9,150 female.

The psychiatric route was a cheap and easy way to get rid of people. They were incarcerated, for decades in some cases, without any due process, no hearing and no appeal.

There are powerful sectors of Irish society who have never been held to account for this appalling injustice. They are, in the first instance, the psychiatrists who happily presided over such a grotesque system. But equally, the State must bear its share of responsibility for funding the operation without questioning the vast numbers of people deprived of their liberty in this way.

And while the numbers may have been reduced and the hospitals become more open, the law governing this area remains today exactly the same as when tens of thousands of Irish people were locked up in such flagrant breach of their rights.

Watching The Asylum, complete with its display of newfound psychiatric glasnost, one might be lulled into thinking that we were merely witnessing the dying legacy of a much harsher era. However, one area

which the documentary series has made clear it is not dealing with is St Joseph's, that part of the Portrane hospital which deals with intellectually disabled patients.

Here, a distinctly different picture emerges. The Inspector of Mental Health Services has been scathing in her criticism of this facility, focusing not just on the poor physical conditions, but also on a culture of care which is profoundly disturbing.

In her most recent report, Dr Teresa Carey highlighted the continued use of straitjackets within this unit, which houses over 200 patients ranging in age from 18 to over 80.

She criticised the lack of any protocol within the institution for the use of restraints of patients generally, which in addition to straitjackets include physically restraining chairs, cot sides, manual restraint and the use of psychotropic medication. She stated that the policy of locking some patients into their rooms at night was in urgent need of review.

There is no multidisciplinary assessment of patients' needs, and the unit has no psychologists, no social workers, no occupational or speech therapists. The standard of accommodation is "unacceptable", maintenance is "poor", and dormitories provide "little scope for privacy or dignity".

This particular picture of an aspect of St Ita's is one which we will not see in The Asylum.

It could be pointed out that the issues of consent to being filmed for patients with intellectual disabilities would be even more difficult than with the mentally ill.

However, it could also be argued that to shine the stark light of a television camera into this particular unit might be considerably more uncomfortable for St Ita's than the picture we have been left with so far of a relic of the bad old days, inhabited by people who sadly call it home, but which is soon to be closed down.

As a society, we have not faced up either to the shocking injustice done to so many thousands of people locked up in psychiatric institutions, or to the gross inadequacies still so prevalent within our mental care system.

In the midst of this, nostalgia for the old institutions has no place.